LCD Reference Article Billing and Coding Article

Billing and Coding: Somatosensory Testing

A57540

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

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General Information

Source Article ID
N/A
Article ID
A57540
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Somatosensory Testing
Article Type
Billing and Coding
Original Effective Date
10/03/2018
Revision Effective Date
03/08/2024
Revision Ending Date
N/A
Retirement Date
N/A

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CMS National Coverage Policy

Social Security Act (Title XVIII) Standard References:

  • Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.

Article Guidance

Article Text

This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L33958 Somatosensory Testing. Please refer to the LCD for reasonable and necessary requirements.

Coding Guidance

Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier. 

Quantitative Sensory Testing (QST) performed with portable hand-held devices (e.g., current, vibration, thermal perception, or tactile) does not represent somatosensory evoked potential testing and should not be billed using the somatosensory codes (95925, 95926, 95927, or 95938). QST testing is considered part of the evaluation and management service, and therefore, should not be billed separately. 

When billing for intraoperative somatosensory testing during spinal surgeries, procedure code 95940 (Continuous intraoperative neurophysiology monitoring in the operating room, one on one monitoring requiring personal attendance ,each 15 minutes [List separately in addition to code for primary procedure]) or G0453 (Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby), per patient (attention directed exclusively to one patient), each 15 minutes list in addition to primary procedure]) should be billed in conjunction with the study performed (95925, 95926, or 95927, or 95938). It would not be acceptable for the performing neurosurgeon to bill for the intraoperative monitoring, as another provider performs this while the surgery is in progress. Intraoperative monitoring performed by a technician is not separately reimbursable. It is not expected that intraoperative testing would be necessary for routine lumbar or cervical root decompression.

Multiple services and/or the bilateral procedure modifiers do not apply, as the code descriptors for these services include “stimulation of any/all peripheral nerves or skin sites". 

Documentation Requirements

  1. All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
  2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
  3. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.
  4. There should be evidence in the medical record that the test results were noted and influenced or contributed to the patient’s course of treatment.
  5. Documentation that the service was performed must be included in the patient’s medical record. This documentation should include a hard copy computer generated recording of the test results along with the physician’s interpretation. The physician’s SEP report should note which nerves were tested, latencies at various testing points, and an evaluation of whether the resulting values are normal or abnormal.
  6. If the provider of somatosensory testing is other than the ordering/referring physician/non-physician practitioner, the provider of the service must maintain a copy of the test results and interpretation, along with copies of the ordering/referring physician/non-physician practitioner’s order for the studies. 

Response To Comments

Number Comment Response
1
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Coding Information

Bill Type Codes

Code Description

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N/A

Revenue Codes

Code Description

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N/A

CPT/HCPCS Codes

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N/A

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

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Group 1 Codes

N/A

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ICD-10-CM Codes that Support Medical Necessity

Group 1

(277 Codes)
Group 1 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes: 95925, 95926, 95927, and 95938.

Group 1 Codes
Code Description
A52.15 Late syphilitic neuropathy
C72.0 Malignant neoplasm of spinal cord
C72.1 Malignant neoplasm of cauda equina
C79.31 Secondary malignant neoplasm of brain
D32.0 Benign neoplasm of cerebral meninges
D32.1 Benign neoplasm of spinal meninges
D33.4 Benign neoplasm of spinal cord
D43.0 Neoplasm of uncertain behavior of brain, supratentorial
D43.1 Neoplasm of uncertain behavior of brain, infratentorial
D43.2 Neoplasm of uncertain behavior of brain, unspecified
D43.4 Neoplasm of uncertain behavior of spinal cord
E03.5 Myxedema coma
E08.40 Diabetes mellitus due to underlying condition with diabetic neuropathy, unspecified
E08.42 Diabetes mellitus due to underlying condition with diabetic polyneuropathy
E09.40 Drug or chemical induced diabetes mellitus with neurological complications with diabetic neuropathy, unspecified
E09.42 Drug or chemical induced diabetes mellitus with neurological complications with diabetic polyneuropathy
E10.40 Type 1 diabetes mellitus with diabetic neuropathy, unspecified
E10.41 Type 1 diabetes mellitus with diabetic mononeuropathy
E10.42 Type 1 diabetes mellitus with diabetic polyneuropathy
E10.43 Type 1 diabetes mellitus with diabetic autonomic (poly)neuropathy
E10.44 Type 1 diabetes mellitus with diabetic amyotrophy
E10.49 Type 1 diabetes mellitus with other diabetic neurological complication
E10.610 Type 1 diabetes mellitus with diabetic neuropathic arthropathy
E11.42 Type 2 diabetes mellitus with diabetic polyneuropathy
E13.40 Other specified diabetes mellitus with diabetic neuropathy, unspecified
E13.42 Other specified diabetes mellitus with diabetic polyneuropathy
G11.0 Congenital nonprogressive ataxia
G11.11 Friedreich ataxia
G11.19 Other early-onset cerebellar ataxia
G11.2 Late-onset cerebellar ataxia
G11.4 Hereditary spastic paraplegia
G13.0 Paraneoplastic neuromyopathy and neuropathy
G13.1 Other systemic atrophy primarily affecting central nervous system in neoplastic disease
G25.3 Myoclonus
G35 Multiple sclerosis
G60.0 Hereditary motor and sensory neuropathy
G60.1 Refsum's disease
G60.2 Neuropathy in association with hereditary ataxia
G60.3 Idiopathic progressive neuropathy
G60.8 Other hereditary and idiopathic neuropathies
G60.9 Hereditary and idiopathic neuropathy, unspecified
G61.0 Guillain-Barre syndrome
G61.1 Serum neuropathy
G61.81 Chronic inflammatory demyelinating polyneuritis
G61.82 Multifocal motor neuropathy
G61.89 Other inflammatory polyneuropathies
G61.9 Inflammatory polyneuropathy, unspecified
G62.0 Drug-induced polyneuropathy
G62.1 Alcoholic polyneuropathy
G62.2 Polyneuropathy due to other toxic agents
G62.81 Critical illness polyneuropathy
G62.82 Radiation-induced polyneuropathy
G62.89 Other specified polyneuropathies
G62.9 Polyneuropathy, unspecified
G63 Polyneuropathy in diseases classified elsewhere
G64 Other disorders of peripheral nervous system
G65.0 Sequelae of Guillain-Barre syndrome
G65.1 Sequelae of other inflammatory polyneuropathy
G65.2 Sequelae of toxic polyneuropathy
G95.0 Syringomyelia and syringobulbia
G95.20 Unspecified cord compression
G95.29 Other cord compression
G95.9 Disease of spinal cord, unspecified
I65.01 Occlusion and stenosis of right vertebral artery
I65.02 Occlusion and stenosis of left vertebral artery
I65.03 Occlusion and stenosis of bilateral vertebral arteries
I65.21 Occlusion and stenosis of right carotid artery
I65.22 Occlusion and stenosis of left carotid artery
I65.23 Occlusion and stenosis of bilateral carotid arteries
I67.1 Cerebral aneurysm, nonruptured
M05.50 Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified site
M05.511 Rheumatoid polyneuropathy with rheumatoid arthritis of right shoulder
M05.512 Rheumatoid polyneuropathy with rheumatoid arthritis of left shoulder
M05.519 Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified shoulder
M05.521 Rheumatoid polyneuropathy with rheumatoid arthritis of right elbow
M05.522 Rheumatoid polyneuropathy with rheumatoid arthritis of left elbow
M05.529 Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified elbow
M05.531 Rheumatoid polyneuropathy with rheumatoid arthritis of right wrist
M05.532 Rheumatoid polyneuropathy with rheumatoid arthritis of left wrist
M05.539 Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified wrist
M05.541 Rheumatoid polyneuropathy with rheumatoid arthritis of right hand
M05.542 Rheumatoid polyneuropathy with rheumatoid arthritis of left hand
M05.549 Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified hand
M05.551 Rheumatoid polyneuropathy with rheumatoid arthritis of right hip
M05.552 Rheumatoid polyneuropathy with rheumatoid arthritis of left hip
M05.559 Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified hip
M05.561 Rheumatoid polyneuropathy with rheumatoid arthritis of right knee
M05.562 Rheumatoid polyneuropathy with rheumatoid arthritis of left knee
M05.569 Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified knee
M05.571 Rheumatoid polyneuropathy with rheumatoid arthritis of right ankle and foot
M05.572 Rheumatoid polyneuropathy with rheumatoid arthritis of left ankle and foot
M05.579 Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified ankle and foot
M05.59 Rheumatoid polyneuropathy with rheumatoid arthritis of multiple sites
M34.83 Systemic sclerosis with polyneuropathy
M47.011 Anterior spinal artery compression syndromes, occipito-atlanto-axial region
M47.012 Anterior spinal artery compression syndromes, cervical region
M47.013 Anterior spinal artery compression syndromes, cervicothoracic region
M47.014 Anterior spinal artery compression syndromes, thoracic region
M47.015 Anterior spinal artery compression syndromes, thoracolumbar region
M47.016 Anterior spinal artery compression syndromes, lumbar region
M47.019 Anterior spinal artery compression syndromes, site unspecified
M47.021 Vertebral artery compression syndromes, occipito-atlanto-axial region
M47.022 Vertebral artery compression syndromes, cervical region
M47.029 Vertebral artery compression syndromes, site unspecified
M47.11 Other spondylosis with myelopathy, occipito-atlanto-axial region
M47.12 Other spondylosis with myelopathy, cervical region
M47.13 Other spondylosis with myelopathy, cervicothoracic region
M47.15 Other spondylosis with myelopathy, thoracolumbar region
M47.22 Other spondylosis with radiculopathy, cervical region
M47.812 Spondylosis without myelopathy or radiculopathy, cervical region
M47.816 Spondylosis without myelopathy or radiculopathy, lumbar region
M48.01 Spinal stenosis, occipito-atlanto-axial region
M48.02 Spinal stenosis, cervical region
M48.03 Spinal stenosis, cervicothoracic region
M48.061 Spinal stenosis, lumbar region without neurogenic claudication
M48.062 Spinal stenosis, lumbar region with neurogenic claudication
M48.07 Spinal stenosis, lumbosacral region
M99.20 Subluxation stenosis of neural canal of head region
M99.21 Subluxation stenosis of neural canal of cervical region
M99.23 Subluxation stenosis of neural canal of lumbar region
M99.30 Osseous stenosis of neural canal of head region
M99.31 Osseous stenosis of neural canal of cervical region
M99.33 Osseous stenosis of neural canal of lumbar region
M99.40 Connective tissue stenosis of neural canal of head region
M99.41 Connective tissue stenosis of neural canal of cervical region
M99.43 Connective tissue stenosis of neural canal of lumbar region
M99.50 Intervertebral disc stenosis of neural canal of head region
M99.51 Intervertebral disc stenosis of neural canal of cervical region
M99.53 Intervertebral disc stenosis of neural canal of lumbar region
M99.60 Osseous and subluxation stenosis of intervertebral foramina of head region
M99.61 Osseous and subluxation stenosis of intervertebral foramina of cervical region
M99.63 Osseous and subluxation stenosis of intervertebral foramina of lumbar region
M99.70 Connective tissue and disc stenosis of intervertebral foramina of head region
M99.71 Connective tissue and disc stenosis of intervertebral foramina of cervical region
M99.73 Connective tissue and disc stenosis of intervertebral foramina of lumbar region
R40.20 Unspecified coma
R40.2110 Coma scale, eyes open, never, unspecified time
R40.2111 Coma scale, eyes open, never, in the field [EMT or ambulance]
R40.2112 Coma scale, eyes open, never, at arrival to emergency department
R40.2113 Coma scale, eyes open, never, at hospital admission
R40.2114 Coma scale, eyes open, never, 24 hours or more after hospital admission
R40.2120 Coma scale, eyes open, to pain, unspecified time
R40.2121 Coma scale, eyes open, to pain, in the field [EMT or ambulance]
R40.2122 Coma scale, eyes open, to pain, at arrival to emergency department
R40.2123 Coma scale, eyes open, to pain, at hospital admission
R40.2124 Coma scale, eyes open, to pain, 24 hours or more after hospital admission
R40.2210 Coma scale, best verbal response, none, unspecified time
R40.2211 Coma scale, best verbal response, none, in the field [EMT or ambulance]
R40.2212 Coma scale, best verbal response, none, at arrival to emergency department
R40.2213 Coma scale, best verbal response, none, at hospital admission
R40.2214 Coma scale, best verbal response, none, 24 hours or more after hospital admission
R40.2220 Coma scale, best verbal response, incomprehensible words, unspecified time
R40.2221 Coma scale, best verbal response, incomprehensible words, in the field [EMT or ambulance]
R40.2222 Coma scale, best verbal response, incomprehensible words, at arrival to emergency department
R40.2223 Coma scale, best verbal response, incomprehensible words, at hospital admission
R40.2224 Coma scale, best verbal response, incomprehensible words, 24 hours or more after hospital admission
R40.2310 Coma scale, best motor response, none, unspecified time
R40.2311 Coma scale, best motor response, none, in the field [EMT or ambulance]
R40.2312 Coma scale, best motor response, none, at arrival to emergency department
R40.2313 Coma scale, best motor response, none, at hospital admission
R40.2314 Coma scale, best motor response, none, 24 hours or more after hospital admission
R40.2320 Coma scale, best motor response, extension, unspecified time
R40.2321 Coma scale, best motor response, extension, in the field [EMT or ambulance]
R40.2322 Coma scale, best motor response, extension, at arrival to emergency department
R40.2323 Coma scale, best motor response, extension, at hospital admission
R40.2324 Coma scale, best motor response, extension, 24 hours or more after hospital admission
R40.2340 Coma scale, best motor response, flexion withdrawal, unspecified time
R40.2341 Coma scale, best motor response, flexion withdrawal, in the field [EMT or ambulance]
R40.2342 Coma scale, best motor response, flexion withdrawal, at arrival to emergency department
R40.2343 Coma scale, best motor response, flexion withdrawal, at hospital admission
R40.2344 Coma scale, best motor response, flexion withdrawal, 24 hours or more after hospital admission
R40.2A Nontraumatic coma due to underlying condition
S12.000A Unspecified displaced fracture of first cervical vertebra, initial encounter for closed fracture
S12.000B Unspecified displaced fracture of first cervical vertebra, initial encounter for open fracture
S12.000D Unspecified displaced fracture of first cervical vertebra, subsequent encounter for fracture with routine healing
S12.000G Unspecified displaced fracture of first cervical vertebra, subsequent encounter for fracture with delayed healing
S12.000K Unspecified displaced fracture of first cervical vertebra, subsequent encounter for fracture with nonunion
S12.000S Unspecified displaced fracture of first cervical vertebra, sequela
S12.001A Unspecified nondisplaced fracture of first cervical vertebra, initial encounter for closed fracture
S12.001B Unspecified nondisplaced fracture of first cervical vertebra, initial encounter for open fracture
S12.001D Unspecified nondisplaced fracture of first cervical vertebra, subsequent encounter for fracture with routine healing
S12.001G Unspecified nondisplaced fracture of first cervical vertebra, subsequent encounter for fracture with delayed healing
S12.001K Unspecified nondisplaced fracture of first cervical vertebra, subsequent encounter for fracture with nonunion
S12.001S Unspecified nondisplaced fracture of first cervical vertebra, sequela
S14.101A Unspecified injury at C1 level of cervical spinal cord, initial encounter
S14.101D Unspecified injury at C1 level of cervical spinal cord, subsequent encounter
S14.101S Unspecified injury at C1 level of cervical spinal cord, sequela
S14.102A Unspecified injury at C2 level of cervical spinal cord, initial encounter
S14.102D Unspecified injury at C2 level of cervical spinal cord, subsequent encounter
S14.102S Unspecified injury at C2 level of cervical spinal cord, sequela
S14.103A Unspecified injury at C3 level of cervical spinal cord, initial encounter
S14.103D Unspecified injury at C3 level of cervical spinal cord, subsequent encounter
S14.103S Unspecified injury at C3 level of cervical spinal cord, sequela
S14.104A Unspecified injury at C4 level of cervical spinal cord, initial encounter
S14.104D Unspecified injury at C4 level of cervical spinal cord, subsequent encounter
S14.104S Unspecified injury at C4 level of cervical spinal cord, sequela
S14.105A Unspecified injury at C5 level of cervical spinal cord, initial encounter
S14.105D Unspecified injury at C5 level of cervical spinal cord, subsequent encounter
S14.105S Unspecified injury at C5 level of cervical spinal cord, sequela
S14.106A Unspecified injury at C6 level of cervical spinal cord, initial encounter
S14.106D Unspecified injury at C6 level of cervical spinal cord, subsequent encounter
S14.106S Unspecified injury at C6 level of cervical spinal cord, sequela
S14.107A Unspecified injury at C7 level of cervical spinal cord, initial encounter
S14.107D Unspecified injury at C7 level of cervical spinal cord, subsequent encounter
S14.107S Unspecified injury at C7 level of cervical spinal cord, sequela
S14.108A Unspecified injury at C8 level of cervical spinal cord, initial encounter
S14.108D Unspecified injury at C8 level of cervical spinal cord, subsequent encounter
S14.108S Unspecified injury at C8 level of cervical spinal cord, sequela
S14.109A Unspecified injury at unspecified level of cervical spinal cord, initial encounter
S14.109D Unspecified injury at unspecified level of cervical spinal cord, subsequent encounter
S14.109S Unspecified injury at unspecified level of cervical spinal cord, sequela
S24.101A Unspecified injury at T1 level of thoracic spinal cord, initial encounter
S24.101D Unspecified injury at T1 level of thoracic spinal cord, subsequent encounter
S24.101S Unspecified injury at T1 level of thoracic spinal cord, sequela
S24.102A Unspecified injury at T2-T6 level of thoracic spinal cord, initial encounter
S24.102D Unspecified injury at T2-T6 level of thoracic spinal cord, subsequent encounter
S24.102S Unspecified injury at T2-T6 level of thoracic spinal cord, sequela
S24.103A Unspecified injury at T7-T10 level of thoracic spinal cord, initial encounter
S24.103D Unspecified injury at T7-T10 level of thoracic spinal cord, subsequent encounter
S24.103S Unspecified injury at T7-T10 level of thoracic spinal cord, sequela
S24.104A Unspecified injury at T11-T12 level of thoracic spinal cord, initial encounter
S24.104D Unspecified injury at T11-T12 level of thoracic spinal cord, subsequent encounter
S24.104S Unspecified injury at T11-T12 level of thoracic spinal cord, sequela
S24.109A Unspecified injury at unspecified level of thoracic spinal cord, initial encounter
S24.109D Unspecified injury at unspecified level of thoracic spinal cord, subsequent encounter
S24.109S Unspecified injury at unspecified level of thoracic spinal cord, sequela
S24.131A Anterior cord syndrome at T1 level of thoracic spinal cord, initial encounter
S24.131D Anterior cord syndrome at T1 level of thoracic spinal cord, subsequent encounter
S24.131S Anterior cord syndrome at T1 level of thoracic spinal cord, sequela
S24.132A Anterior cord syndrome at T2-T6 level of thoracic spinal cord, initial encounter
S24.132D Anterior cord syndrome at T2-T6 level of thoracic spinal cord, subsequent encounter
S24.132S Anterior cord syndrome at T2-T6 level of thoracic spinal cord, sequela
S24.133A Anterior cord syndrome at T7-T10 level of thoracic spinal cord, initial encounter
S24.133D Anterior cord syndrome at T7-T10 level of thoracic spinal cord, subsequent encounter
S24.133S Anterior cord syndrome at T7-T10 level of thoracic spinal cord, sequela
S24.134A Anterior cord syndrome at T11-T12 level of thoracic spinal cord, initial encounter
S24.134D Anterior cord syndrome at T11-T12 level of thoracic spinal cord, subsequent encounter
S24.134S Anterior cord syndrome at T11-T12 level of thoracic spinal cord, sequela
S24.139A Anterior cord syndrome at unspecified level of thoracic spinal cord, initial encounter
S24.139D Anterior cord syndrome at unspecified level of thoracic spinal cord, subsequent encounter
S24.139S Anterior cord syndrome at unspecified level of thoracic spinal cord, sequela
S24.151A Other incomplete lesion at T1 level of thoracic spinal cord, initial encounter
S24.151D Other incomplete lesion at T1 level of thoracic spinal cord, subsequent encounter
S24.151S Other incomplete lesion at T1 level of thoracic spinal cord, sequela
S24.152A Other incomplete lesion at T2-T6 level of thoracic spinal cord, initial encounter
S24.152D Other incomplete lesion at T2-T6 level of thoracic spinal cord, subsequent encounter
S24.152S Other incomplete lesion at T2-T6 level of thoracic spinal cord, sequela
S24.153A Other incomplete lesion at T7-T10 level of thoracic spinal cord, initial encounter
S24.153D Other incomplete lesion at T7-T10 level of thoracic spinal cord, subsequent encounter
S24.153S Other incomplete lesion at T7-T10 level of thoracic spinal cord, sequela
S24.154A Other incomplete lesion at T11-T12 level of thoracic spinal cord, initial encounter
S24.154D Other incomplete lesion at T11-T12 level of thoracic spinal cord, subsequent encounter
S24.154S Other incomplete lesion at T11-T12 level of thoracic spinal cord, sequela
S24.159A Other incomplete lesion at unspecified level of thoracic spinal cord, initial encounter
S24.159D Other incomplete lesion at unspecified level of thoracic spinal cord, subsequent encounter
S24.159S Other incomplete lesion at unspecified level of thoracic spinal cord, sequela
S34.101A Unspecified injury to L1 level of lumbar spinal cord, initial encounter
S34.101D Unspecified injury to L1 level of lumbar spinal cord, subsequent encounter
S34.101S Unspecified injury to L1 level of lumbar spinal cord, sequela
S34.102A Unspecified injury to L2 level of lumbar spinal cord, initial encounter
S34.102D Unspecified injury to L2 level of lumbar spinal cord, subsequent encounter
S34.102S Unspecified injury to L2 level of lumbar spinal cord, sequela
S34.103A Unspecified injury to L3 level of lumbar spinal cord, initial encounter
S34.103D Unspecified injury to L3 level of lumbar spinal cord, subsequent encounter
S34.103S Unspecified injury to L3 level of lumbar spinal cord, sequela
S34.104A Unspecified injury to L4 level of lumbar spinal cord, initial encounter
S34.104D Unspecified injury to L4 level of lumbar spinal cord, subsequent encounter
S34.104S Unspecified injury to L4 level of lumbar spinal cord, sequela
S34.105A Unspecified injury to L5 level of lumbar spinal cord, initial encounter
S34.105D Unspecified injury to L5 level of lumbar spinal cord, subsequent encounter
S34.105S Unspecified injury to L5 level of lumbar spinal cord, sequela
S34.109A Unspecified injury to unspecified level of lumbar spinal cord, initial encounter
S34.109D Unspecified injury to unspecified level of lumbar spinal cord, subsequent encounter
S34.109S Unspecified injury to unspecified level of lumbar spinal cord, sequela
S34.139A Unspecified injury to sacral spinal cord, initial encounter
S34.139D Unspecified injury to sacral spinal cord, subsequent encounter
S34.139S Unspecified injury to sacral spinal cord, sequela
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ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

(1 Code)
Group 1 Paragraph

All those not listed under the “ICD-10-CM Codes that Support Medical Necessity” section of this article.

Group 1 Codes
Code Description
XX000 Not Applicable
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ICD-10-PCS Codes

Group 1

Group 1 Paragraph

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Group 1 Codes

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Additional ICD-10 Information

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Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description

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N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code Description

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Other Coding Information

Group 1

Group 1 Paragraph

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Group 1 Codes

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Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Revision History Information

Revision History Date Revision History Number Revision History Explanation
03/08/2024 R3

Article revised and published on 07/25/2024 effective for dates of service on and after 03/08/2024. The following ICD-10-CM codes have been added to Group 1 Codes: D32.0, D32.1, I65.01, I65.02, I65.03, I65.21, I65.22, I65.23, I67.1, M47.15, M47.22, M47.812, and M47.816. This revision is in response to an inquiry. Minor formatting changes have been made throughout the article.

10/01/2023 R2

Article revised and published on 10/26/2023 effective for dates of service on and after 10/01/2023 to reflect the Annual ICD-10-CM Code Updates. The following ICD-10-CM code has been added to the article: R40.2A in Code Group 1.

10/01/2020 R1

Revision Number: 1
Publication: September 2020 Connection
LCR B2020-013

Explanation of Revision: Based on review for Annual ICD-10-CM Code Updates, ICD-10-CM codes G11.11 and G11.19 have been added to the billing and coding article Group 1. ICD-10-CM code G11.1 has been deleted and therefore has been removed from the billing and coding article Group 1. Additional formatting changes have been made throughout the document. The effective date of this revision is for dates of service on or after October 1, 2020.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L33958 - Somatosensory Testing
Related National Coverage Documents
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SAD Process URL 2
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